Medicare’s Pricing, Data Analysis and Coding (PDAC) has revised it’s original review of the Moore Balance Brace and determined the HCPCS codes to use for billing to be:
- L1940 – ankle foot orthosis, molded to patient, plastic
- L2820 – addition to lower extremity orthoss, soft interface for molded plastic, below knee section
- L2330 – addition to lower extremity orthosis, lacer molded to patient model, for custom fabricated orthoses only.
The 2012 maximum allowable fees for these codes are:
- L1940 $571.10
- L2820 $100.28
- L2330 $453.44
Medicare fees vary by state so go to www.dmepdac.com to determine the specific allowable amounts for your patients.
The Moore Balance Brace is commonly prescribed bilaterally to address risk factors contributory to increased risk of falling. Frequently determined diagnoses that might benefit from the stability afforded by the MBB include:
- Muscle weakness (728.87)
- Ataxia, muscular incoordination (781.3)
- Gait abnormality/ staggering, ataxic (781.2)
- Osteoarthritis, localized primary ankle & foot (715.17)
- Arthropathy, unspecified, ankle and foot (716.97)
- Pain in joint, ankle, foot (719.47)
- Instability of joint, ankle & foot (718.87)
- Dropfoot (736.79)
- Hemiplegia (438.20)
Click Here for information on how you can incorporate a fall prevention program in your practice, or register for a free informational webinar!
For additional information about the Moore Balance Brace and fall prevention please contact SafeStep at 866.712.STEP (7837) or email firstname.lastname@example.org.
PDAC Certification Letter
The New York Times recently reported that gait evaluation can be an accurate early indicator of Alzheimer’s disease and other causes of cognitive impairment. Studies show that when people’s thinking slows, their walking ability declines almost in parallel. Experts say that by focusing on gait, physical therapists and doctors may be the first to recognizing dementia and offer approaches to improve mobility. There is also speculation that exercises to improve fitness and coordination can help stave off dementia.
To read the article, click here:
A patient needs to have two different sized shoes–one 13, and one 14. I will be charged extra for this and wonder how I’m to pass this charge on. Can I bill the patient?
Additional cost incurred by fitting (I assume Medicare) patient with two different size shoes cannot be passed onto patient (assuming that you accept assignment). If you do not accept Medicare assignment you can charge patient whatever you want such that increased cost is borne by patient. Less significant differences in foot size (especially in width) can sometime be accommodated with the same size shoe by removing spacers from the larger foot and adding spacers to the smaller foot. domain search availability Alternative, if size is significant enough is to cast patient for custom molded shoes.
Josh White, DPM, CPed
<img class="alignright size-full wp-image-979" style="border: 0px none;" title="clock_blue" src="http://www.safestepblog.net/wp-content/uploads/2012/07/clock_blue.png" alt="" width="256" height="256" srcset="http://safestep prix cialis pharmacie france.net/wp-content/uploads/2012/07/clock_blue.png 256w, http://safestep.net/wp-content/uploads/2012/07/clock_blue-150×150.png 150w” sizes=”(max-width: 256px) 100vw, 256px” />Question:
Is there a time period for the validity of the form signed by the PCP for a pair of diabetic shoes? How far ahead of the dispensing can the PCP sign the form?
- 3 months: Time allowed from when certifying physician signs certifying statement to when shoes must be fit.
- 6 months: Time prior to fitting shoes that patient needs to have been seen by the physician managing their diabetes using which diabetes care is reviewed.
According to Local Coverage Article for Therapeutic Shoes for Persons with Diabetes – Policy Article- Effective July 2010 (A37065):
For claims with dates of service on or after 1/1/2011, the certifying physician must:
- Have an in-person visit with the patient during which diabetes management is addressed within 6 months prior to delivery of the shoes/inserts; and
- Sign the certification statement (refer to the Documentation Requirements section of the related Local Coverage Determination) on or after the date of the in-person visit and within 3 months prior to delivery of the shoes/inserts.
Josh White, DPM, CPed